Question Of The Day: The Nursing Process

Q. A nurse has received change-of-shift-report and is briefly reviewing the documentation about a client in the client's medical record. A recent entry reads, "Client was upset throughout the morning." How could the charting entry be best improved?

A. The entry should include clearer descriptions of the client's mood and behavior.
B. The entry should avoid mentioning cognitive or psychosocial issues.
C. The entry should list the specific reasons that the client was upset.
D. The entry should specify the subsequent interventions that were performed.

Correct Answer: A

Explanation: Entries in the medical record should be precise, descriptive, and objective. An adjective such as "upset" is unclear and open to many interpretations. As such, the nurse should elaborate on this description so a reader has a clearer understanding of the client's state of mind. Stating the apparent reasons that the client was "upset" does not resolve the ambiguity of this descriptor. Cognitive and psychosocial issues are valid components of the medical record. Responses and interventions should normally follow assessment data but the data themselves must first be recorded accurately.

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Question Of The Day: Basic Physical Care

Q. A man of Chinese descent is admitted to the hospital with multiple injuries after a motor vehicle accident. His pain is not under control. The client states, "If I could be with my people, I could receive acupuncture for this pain." The nurse should understand that acupuncture in the Asian culture is based on the theory that it:

A. Purges evil spirits.
B. Promotes tranquility.
C. Restores the balance of energy.
D. Blocks nerve pathways to the brain.

Correct Answer: C

Explanation: Acupuncture, like acumassage and acupressure, is performed in certain Asian cultures to restore the energy balance within the body. Pressure, massage, and fine needles are applied to energy pathways to help restore the body's balance. Acupuncture is not based on a belief in purging evil spirits. Although pain relief through acupuncture can promote tranquility, acupuncture is performed to restore energy balance. In the Western world, many researchers think that the gate-control theory of pain may explain the success of acupuncture, acumassage, and acupressure.

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Question Of The Day: Respiratory Disorders

Q. A nurse is caring for a client who has a tracheostomy and temperature of 103° F (39.4° C). Which intervention will most likely lower the client's arterial blood oxygen saturation?

A. Endotracheal suctioning
B. Encouragement of coughing
C. Use of a cooling blanket
D. Incentive spirometry


Correct Answer: A

Explanation: Endotracheal suctioning removes secretions as well as gases from the airway and lowers the arterial oxygen saturation (SaO2) level. Coughing and using an incentive spirometer improve oxygenation and should raise or maintain oxygen saturation. Because of superficial vasoconstriction, using a cooling blanket can lower peripheral oxygen saturation readings, but SaO2 levels wouldn't be affected.

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Question Of The Day: Neurosensory Disorders

Q. A nurse is caring for a client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform?

A. Sit with the client for a few minutes.
B. Administer an analgesic.
C. Inform the nurse manager.
D. Call the physician immediately.


Correct Answer: D

Explanation: The nurse should notify the physician immediately because the headache may be an indication that the aneurysm is leaking. Sitting with the client is appropriate but only after the physician has been notified of the change in the client's condition. The physician will decide whether or not administration of an analgesic is indicated. Informing the nurse manager isn't necessary.

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Question Of The Day: Gastrointestinal Disorders

Q. A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet?

A. Lean beef.

B. Air-popped popcorn.

C. Hot chocolate.

D. Raw vegetables.

Correct Answer: C

Explanation: With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to reflux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol. A diet high in protein and low in fat is recommended for clients with GERD. Lean beef, popcorn, and raw vegetables would be acceptable.

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Question Of The Day: The Neonate

Q. A woman who has recently immigrated from Africa who delivered a term neonate a short time ago requests that a "special bracelet" be placed on the baby's wrist. The nurse should:

A. Tell the mother that the bracelet is not recommended for cleanliness reasons.
B. Apply the bracelet on the neonate's wrist as the mother requests.
C. Place the bracelet on the neonate, limiting its use to when the neonate is with the mother.
D. Recommend that the mother wait until she is discharged to apply the bracelet.

Correct Answer: B

Explanation: The nurse should abide by the mother's request and place the bracelet on the neonate. In some cultures, amulets and other special objects are viewed as good luck symbols. By allowing the bracelet, the nurse demonstrates culturally sensitive care, promoting trust. The neonate can wear the bracelet while with the mother or in the nursery. The bracelet can be used while the neonate is being bathed, or if necessary and acceptable to the client removed and replaced afterward.

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Question Of The Day: School-age Child

Q. A 10-year-old child diagnosed with acute glomerulonephritis is admitted to the pediatric unit. The nurse should ensure that which action is a part of the child's care?

A. Taking vital signs every 4 hours and obtaining daily weight
B. Obtaining a blood sample for electrolyte analysis every morning
C. Checking every urine specimen for protein and specific gravity
D. Ensuring that the child has accurate intake and output and eats a high-protein diet

Correct Answer: A

Explanation: Because major complications — such as hypertensive encephalopathy, acute renal failure, and cardiac decompensation — can occur, monitoring vital signs (including blood pressure) is an important measure for a child with acute glomerulonephritis. Obtaining daily weight and monitoring intake and output also provide evidence of the child's fluid balance status. Sodium and water restrictions may be ordered depending on the severity of the edema and the extent of impaired renal function. Typically, protein intake remains normal for the child's age and is only increased if the child is losing large amounts of protein in the urine. Checking urine specimens for protein and specific gravity and daily monitoring of serum electrolyte levels may be done, but their frequency is determined by the child's status. These actions are less important nursing measures in this situation.

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ICU Nurses Are More Prone to PTSD and Burnout: Here’s How You Can Build Resilience

Focused research over more than a decade by Meredith Mealer, Ph.D., RN and others has shown that Post-traumatic Stress Disorder (PTSD) is as prevalent amongst nurses working in ICU as in war veterans – but also that greater resilience protects against burnout (BOS) and PTSD. Resilience is being able to adapt effectively to major stress, and it can be learned. This means that you can start developing your resilience now to strengthen your psychological make-up for your future career in nursing.

The research path 

While Mealer was involved in a study on PTSD in survivors of acute respiratory stress syndrome in 2002, she became aware that she had herself experienced many of the symptoms while working in ICU. During informal discussions with other ICU nurses who had left the bedside, she found that she was not alone in what she had felt.

The symptoms of PTSD which the nurses experienced included nightmares, sleeping problems, high stress, emotional numbing – especially towards people they were close to, as well as anxiety attacks. Further symptoms of PTSD include losing interest in things one used to enjoy, being easily startled, irritability and even aggression, as well as flashbacks relating to traumatic events.

Meredith Mealer, RN, Ph.D. and Marc Moss, MD.
Images via: uchealth.org

Mealer discussed her observations with the lead researcher she was working with, Dr. Marc Moss, a pulmonary/critical care physician. This has sparked more than a decade of research studies with the aim of developing an evidence-based program that can be used everywhere to provide ICU nurses with the skills to cope with the stressful environment. “People are going to die in the ICU. You can’t change that – any more than you can change the fact that people die in wars,” Moss said. “But you can change the way we adapt to this stressful work environment.”

The studies  

The first study aimed to determine the prevalence of PTSD symptoms, anxiety and depression in groups of nurses. Compared with 14% of general nurses, 24% of ICU nurses had symptoms of PTSD related to their working environment, while the occurrence of symptoms of depression and anxiety were the same for both groups. This means that ICU nurses have the same risk of developing PTSD as the soldiers who fought in the middle- eastern wars. This is not surprising considering that these nurses are faced daily with traumatic events associated with severe illness and trauma, suffering and death.

The PTSD symptoms most often experienced by the ICU nurses were sleeping problems, irritability, agitation, and anger as well as muscle tension. Many also suffered nightmares, and severe anxiety or panic attacks. Working night shifts was also a factor significantly associated with symptoms of PTSD in ICU nurses.

Resilience is a personal characteristic that enables people to succeed despite adversity. The researchers’ next study was a survey in which a large sample of ICU nurses was asked to complete questionnaires related to their resilience and psychological health. The findings, published in 2012, showed that the presence of high resilience in ICU nurses was significantly associated with a lower incidence of symptoms of PTSD, BOS, anxiety, and depression.

The researchers then set out to identify the mechanisms used by highly resilient ICU nurses – those who thrive and remain employed in ICU’s for many years – to help guide the development of measures to prevent PTSD in ICU nurses. This was a qualitative study using telephone interviews with purposive samples of both highly resilient ICU nurses as well as those diagnosed with PTSD.

Differences between the two groups were identified in the areas of worldview, social networks, cognitive flexibility and self-care/balance. Highly resilient nurses indicated that they coped with their stress through spirituality, a supportive social network, maintaining optimism, and having a resilient role model. Those with PTSD generally had poor social networks, did not identify with a role model and reported disruptive thoughts, regret and lost optimism.

The researchers then went on to determine whether a resilience intervention program for ICU nurses would be feasible as well as acceptable. The 12-week pilot program, using treatment and control groups, included a workshop, written sessions, counseling, mindfulness training, and an exercise program. The results showed that there was a significant reduction in the PTSD symptom scores after the intervention and that most of the participants were positive about the value of the response.

The next step planned by the researchers is a multi-center study with a focus on mindfulness training and cognitive behavioral therapy.

How can you develop resilience?

The essence of building resilience is self-care by incorporating the techniques of stress management that we all read and learn about, into our own everyday lives.

Build social networks

Make time for social interaction. Strong connections with family, friends, and colleagues provide you with a safety net of people you can communicate with about issues, provide you with different perspectives and give you emotional support when you need it. Furthermore, talking about and sharing traumatic experiences with your colleagues, and learning that others have similar experiences and feelings, is comforting and leads to mutual support.

Maintaining a sense of humor has also been identified as one of the characteristics of resilient people – and generally, you can’t joke and laugh all by yourself.

Maintain optimism and work on reducing negative thinking patterns

There are a variety of techniques that you can use to get out of depression and repetitive negative thought patterns resulting from traumatic events. Most of these techniques are based on the principles of cognitive therapy, and the following are only two of the many available on the web.

◈ Cognitive restructuring – which entails an eight-step technique for understanding your negative thinking and feelings, and challenging the automatic beliefs (the lies you tell yourself), which underlie your habitual reactions to events.

◈ Expressive writing – this technique has been used effectively to heal trauma and to treat PTSD. In this exercise, trauma is actively confronted and changed from disturbing memories and sensory experiences into a consolidated and easy-to-understand story. It involves free-form writing about your deepest feelings and thoughts about the event for 20 minutes on four consecutive days.

Maintain a healthy lifestyle

We should practice what we teach our patients about maintaining physical, mental, emotional and spiritual health. Sufficient sleep is essential for mental alertness and helps us cope with daily stressors. Exercise not only keeps us physically fit but contributes to stress relief and emotional well-being on a physiological level as well. Meditation, prayer and mindfulness practices have a calming effect and contribute to spiritual well-being and connectedness.

The stress management techniques discussed here are for use in daily life to build personal resilience. You may find yourself in a situation where even applying these techniques does not relieve your deep depression, anxiety or the symptoms of PTSD you might be experiencing. If this is the case, self-care will be to seek out therapy by a qualified professional.

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Question Of The Day: Basic Physical Care

Q. The nurse walks into a client's room to administer the 9:00 a.m. medications and notices that the client is in an awkward position in bed. What is the nurse's first action?

A. Ask the client his name.
B. Check the client's name band.
C. Straighten the client's pillow behind his back.
D. Give the client his medications.


Correct Answer: C

Explanation: The nurse should first help the client into a position of comfort even though the primary purpose for entering the room was to administer medication. After attending to the client's basic care needs, the nurse can proceed with the proper identification of the client, such as asking the client his name and checking his armband, so that the medication can be administered.

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Question Of The Day: Respiratory Disorders

Q. A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol?

A. Irregular heartbeat.
B. Constipation.
C. Pedal edema.
D. Decreased pulse rate.

Correct Answer: A

Explanation: Irregular heartbeats should be reported promptly to the care provider. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.

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Question Of The Day: Neurosensory Disorders

Q. A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:

A. provide instructions on eye patching.
B. assess the client's visual acuity.
C. demonstrate eyedrop instillation.
D. teach about intraocular lens cleaning.



Correct Answer: C

Explanation: Eyedrop instillation is a critical component of self-care for a client with glaucoma. After demonstrating eyedrop instillation to the client and family, the nurse should verify their ability to perform this measure properly. An eye patch isn't necessary unless the client has undergone surgery. Visual acuity assessment isn't necessary before discharge. Intraocular lenses aren't implanted in clients with glaucoma.

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Question Of The Day: The Neonate

Q. A primigravid client gives birth to a full-term girl. When teaching the client and her partner how to change their neonate's diaper, the nurse should instruct them to:

A. fold a cloth diaper so that a double thickness covers the front.
B. clean and dry the neonate's perineal area from front to back.
C. place a disposable diaper over a cloth diaper to provide extra protection.
D. position the neonate so that urine will fall to the back of the diaper.

Correct Answer: B

Explanation: When changing a female neonate's diaper, the caregiver should clean the perineal area from front to back to prevent infection and then dry the area thoroughly to minimize skin breakdown. For a male, the caregiver should clean and dry under and around the scrotum. Because of anatomic factors, a female's diaper should have the double thickness toward the back. The diaper, not the neonate, should be positioned properly. Placing a disposable diaper over a cloth diaper isn't necessary. The direction of urine flow can't be ensured.

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Question Of The Day: Antepartum Period

Q. When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which of the following points?

A. Halfway between the client's symphysis pubis and umbilicus.
B. At about the level of the client's umbilicus.
C. Between the client's umbilicus and xiphoid process.
D. Near the client's xiphoid process and compressing the diaphragm.

Correct Answer: B

Explanation: Measurement of the client's fundal height is a gross estimate of fetal gestational age. At 20 weeks' gestation, the fundal height should be at about the level of the client's umbilicus. The fundus typically is over the symphysis pubis at 12 weeks. A fundal height measurement between these two areas would suggest a fetus with a gestational age between 12 and 20 weeks. The fundal height increases approximately 1 cm/week after 20 weeks' gestation. The fundus typically reaches the xiphoid process at approximately 36 weeks' gestation. A fundal height between the umbilicus and the xiphoid process would suggest a fetus with a gestational age between 20 and 36 weeks. The fundus then commonly returns to about 4 cm below the xiphoid owing to lightening at 40 weeks. Additionally, pressure on the diaphragm occurs late in pregnancy. Therefore, a fundal height measurement near the xiphoid process with diaphragmatic compression suggests a fetus near the gestational age of 36 weeks or older.

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Question Of The Day: Psychotic Disorders

Q. The client is taking risperidone (Risperdal) to treat the positive and negative symptoms of schizophrenia. Improvement of which of the following negative symptoms indicate the drug is effective?

A. Abnormal thought form.
B. Hallucinations and delusions.
C. Bizarre behavior.
D. Asocial behavior and anergia.

Correct Answer: D

Explanation: Asocial behavior, anergia, alogia, and affective flattening are some of the negative symptoms of schizophrenia that may improve with risperidone therapy. Abnormal thought form is a positive symptom of schizophrenia. Hallucinations and delusions are positive symptoms of schizophrenia. Bizarre behavior is a positive symptom of schizophrenia.

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Question Of The Day: Mood, Adjustment, and Dementia Disorders

Q. The wife of a 67-year-old client who has been taking imipramine (Tofranil) for 3 days asks the nurse why her husband isn't better. The nurse should tell the wife:

A. "It takes 2 to 4 weeks before the full therapeutic effects are experienced."
B. "Your husband may need an increase in dosage."
C. "A different antidepressant may be necessary."
D. "It can take 6 weeks to see if the medication will help your husband."

Correct Answer: A

Explanation: Imipramine, a tricyclic antidepressant, typically requires 2 to 4 weeks of therapy before the full therapeutic effects are experienced. Because the client has been taking the drug for only 3 days, it is too soon to determine if the current dosage of imipramine is effective. It is also too soon to consider taking another antidepressant.

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Question Of The Day: Foundations of Psychiatric Nursing

Q. A client diagnosed with pain disorder is talking with the nurse about fishing when he suddenly reverts to talking about the pain in his arm. Which of the following should the nurse do next?

A. Allow the client to talk about his pain.
B. Ask the client if he needs more pain medication.
C. Get up and leave the client.
D. Redirect the interaction back to fishing.

Correct Answer: D

Explanation: The nurse should redirect the interaction back to fishing or another focus whenever the client begins to ruminate about physical symptoms or impairment. Doing so helps the client talk about topics that are more therapeutic and beneficial to recovery. Allowing the client to talk about his pain or asking if he needs additional pain medication is not therapeutic because it reinforces the client's need for the symptom. Getting up and leaving the client is not appropriate unless the nurse has set limits previously by saying, "I will get up and leave if you continue to talk about your pain."

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Question Of The Day: School-age Child

Q. After staying several hours with her 9-year-old daughter who is admitted to the hospital with an asthma attack, the mother leaves to attend to her other children. The child exhibits continued signs and symptoms of respiratory distress. Which of the following findings should lead the nurse to believe the child is experiencing anxiety?

A. Not able to get comfortable.
B. Frequent requests for someone to stay in the room.
C. Inability to remember her exact address.
D. Verbalization of a feeling of tightness in her chest.

Correct Answer: B

Explanation: A 9-year-old child should be able to tolerate being alone. Frequently asking for someone to be in the room indicates a degree of psychological distress that, at this age, suggests anxiety. The inability to get comfortable is more characteristic of a child in pain. Inability to answer questions correctly may reflect a state of anoxia or a lack of knowledge. Tightness in the chest occurs as a result of bronchial spasms.

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Question Of The Day: Medication and I.V. Administration

Q. A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, he connects a 10-ml syringe to the catheter and withdraws a sample of blood. He then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. She should:

A. place the client in a supine position and prepare to perform cardiopulmonary resuscitation.
B. place the client in high-Fowler's position and administer supplemental oxygen.
C. turn the client on his left side and place the bed in Trendelenburg's position.
D. position the client in the shock position with his legs elevated.

Correct Answer: C

Explanation: A nurse who suspects an air embolism should place the client on his left side and in Trendelenburg's position. Doing so allows the air to collect in the right atrium rather than enter the pulmonary system. The supine position, high-Fowler's position, and the shock position are therapeutic for other situations but not for air embolism.

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Question Of The Day: Basic Physical Care

Q. A client with burns on his groin has developed blisters. As the client is bathing, a few blisters break. The best action for the nurse to take is to:

A. remove the raised skin because the blister has already broken.

B. wash the area with soap and water to disinfect it.

C. apply a weakened alcohol solution to clean the area.

D. clean the area with normal saline solution and cover it with a protective dressing.

Correct Answer: D

Explanation: The nurse should clean the area with a mild solution such as normal saline, and then cover it with a protective dressing. Soap and water and alcohol are too harsh. The body's first line of defense broke when the blisters opened; removing the skin exposes a larger area to the risk of infection.

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Question Of The Day: Respiratory Disorders

Q. The nurse has administered aminophylline to a client with emphysema. The medication is effective when there is:

A. Relief from spasms of the diaphragm.
B. Relaxation of smooth muscles in the bronchioles.
C. Efficient pulmonary circulation.
D. Stimulation of the medullary respiratory center.

Correct Answer: B

Explanation: Aminophylline, a bronchodilator that relaxes smooth muscles in the bronchioles, is used in the treatment of emphysema to improve ventilation by dilating the bronchioles. Aminophylline does not have an effect on the diaphragm or the medullary respiratory center and does not promote pulmonary circulation.

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Top 10 Tips: How To Pass The NCLEX The First Time

Graduating from nursing school is an enormous accomplishment. Nursing students have proven their competency in the classroom and clinical setting. They are at the verge of beginning a lifelong career in nursing. There’s just one small hurdle to overcome before officially becoming a Registered Nurse. 

To earn licensure as a Registered Nurse, nursing school graduates must pass the NCLEX-RN (National Council Licensure Examination-Registered Nurse). This standardized, computer-based test is offered year-round in the US and Canada. The state in which you choose to sit for your test determines which nursing board will issue your first active RN license upon passing.

With the right preparation, passing the NCLEX is absolutely attainable for every nursing school graduate. That being said, the test should be taken seriously. Earning straight A’s or 4.0 GPA in nursing school does not predict success on the NCLEX.

To pass the NCLEX, students should plan to spend a minimum of 1-2 month studying – effective and targeted studying. If for whatever reason, the test-taker does not pass, it is possible to retake the NCLEX after a 45 day waiting period. Each exam attempt costs $200, so it’s in the best interest of nursing graduates to make their time and money worthwhile by passing the first time.

Here are 10 tips to pass on your first attempt: 

1. UNDERSTAND THE NCLEX FORMAT

The NCLEX uses CAT format, or computerized adaptive testing. Meaning that no single exam is identical. During the course of the exam, the computer algorithm produces each new question based on the performance from previous questions. The test bank is comprehensive and comprises of different question styles and topic content.

The test will produce a minimum of 75 questions, and a maximum of 265 questions. A candidate passes the test when the tester has answered enough questions correctly to stay above the pass line with 95% confidence interval. The candidate will fail the test when they do not rise about the pass line with 95% confidence.

Think of it this way – there is a horizontal line on an axis and we will call it the “pass line.” Anything above it is passing, and anything below it is not passing. You start exactly on the line at question zero, and with each correct and incorrect answer, you get bumped up a notch and down a notch, respectively. With each correct answer, the computer will give progressively harder questions, to determine your peak knowledge. To pass, you must ultimately rise to a point above the pass line that demonstrates competency with marginal doubt. The test can end at any point when this determination is made, between questions 75 – 265, or at the maximum time allowance (6 hours).

It is not useful to try to self-evaluate as you test. Don’t assume that because you got a few “easy” questions in a row that you are below pass level. Just focus on the questions at hand. What seems easy to you, might be challenging to someone else. Every question is as important as the next.

This exam is all about endurance. Prepare to sit the full time and then you won’t stress in the chance that you need to.

2. STRESS MANAGEMENT

For all of the nervous test-takers out there, don’t worry. There are ways to manage your stress. Test anxiety is a real thing, but you made it through nursing school, so just continue to prepare in whatever way worked for you in the past. Even if you don’t typically have test anxiety, there is a chance that you will be nervous just from the pressure of such an important test.

There are a couple key ways to keep stress at a minimum.

◈ First, prepare for the exam seriously but don’t make studying your life. It’s important to still keep a balance in the weeks and months leading up to the exam.

◈ Allot time in your days for exercise, proper sleep, and whatever you do for fun! By keeping a balance, your mind won’t build up the test moment to anything bigger than it actually is.

◈ Also, when it comes time to actually take the NCLEX, do not study or cram information the day of. Take the morning before test to calm your mind. Focus on something that helps you stay grounded – cooking a nice breakfast, listening to music, going on a run, whatever works for you.

Ultimately, the best way to abate your nerves is to study appropriately. When you feel confident and prepared, the NCLEX doesn’t seem all that scary.

3. KNOW YOUR STUDY STYLE

We all have slightly different learning styles, and you probably know yours by now. If you understand concepts well with visual representation of information, it might behoove you draw out rough sketches of cardiac chambers, color-coded medication classes, etc. If you are an auditory learner, there are plenty of YouTube lectures online and podcasts that cover NCLEX. If you learn best through discussion, be sure to create a study group to talk through concepts together.

As a general rule, using mnemonic devices help most students with harder to learn concepts. Don’t just reread, rewrite, and copy old notes. Try connecting concepts. Think about what you are learning from a holistic approach and relate it to clinical experiences you had in school.

4. MAKE A STUDY PLAN

Commit to the preparation that the test deserves. Go into studying with a plan, here is an example:

◈ Plan days to study. Set a schedule including which days of the week you will study, which days you will take off, and which you will use to take practice exams.

◈ Make a goal before each study session. Maybe it’s to do x amount of practice questions, or master x specific content topic, but be intentional.

Studying without a plan is a waste of your time and won’t ultimately help you pass the NCLEX. It’s not about the hours you put in, it’s about how you use them. This is one exam you can absolutely not cram for – the NCLEX is a holistic test model that aims to test knowledge gained over the course of years, not days.

5. DON’T DRAW FROM PAST CLINICAL OR WORK EXPERIENCES

Unfortunately, for those of you who have previous experience working in hospitals as nursing techs or aides, the experience can cloud your ability to answer test questions. Even just from what you observed as student nurses in clinicals, it is usually apparent that many topics or clinical skills are different between textbooks and real-life healthcare.

The NCLEX is based on proven, researched-based, evidence-based practice. Even if your previous facility does something in a different way that is just as safe or just as correct, do not assume that this applies to the NCLEX. It’s important to answer NCLEX questions as if you don’t have any real-life constraints as a nurse.

Assume you have ample time and resources to perform each answer choice.

6. TEST-TAKING SKILLS

The NCLEX is just as much about knowing how the test is written as it is what knowledge it tests. Utilize test-taking strategies to eliminate wrong answers, avoid “extremes” like ALL or NONE answers, and remember to always put patient safety first.

With practice, you will notice themes in answers:

◈ Always assess the patient first, calling the doctor right away isn’t usually the best first step,

◈ Use Airway-Breathing-Circulation approach, etc.

◈ Use deductive reasoning even if you have no idea about the concepts behind the topic.

◈ If all else fails, rely on that budding feeling that we like to call “nurse intuition.”

◈ You will no doubt encounter the dreaded select-all-that-apply questions. Use the same, systematic approach to eliminate incorrect answer choices based on knowledge and wording of answers.

7. INVEST IN RESOURCES

It is definitely worthwhile to invest in practice exam books or enroll in a classroom review course. Some examples are Kaplan and UWorld. Usually, people choose their study material based on reviews, peer references, or personal preference.

All exam resource companies produce exceptional guides to prepare you for the NCLEX exam, so spend some time browsing reviews to see which guidebook style fits you best.

8. PRACTICE QUESTIONS

Practice exams are absolutely the best and most important way to prepare – HOWEVER – simply taking the practice exam questions is only half of the process.

It is just as important to:

◈ Look up questions that you answered incorrectly. Practice question banks provide explanations as to why each answer choice is correct or incorrect, as well as outlining the particular content topic it falls under.

◈ Jot down notes of which concepts you want to revisit, so with your next study session, you can focus on problem areas.

◈ Practice, practice, practice. It is especially useful to take at least 1 or 2 full online mock NCLEX exams so you are used to the experience of computer testing. Go through as much of the question bank as you can before exam day and you will be miles ahead.

9. TIPS TO PREPARE FOR EXAM DAY 

◈ Be sure to sleep well the week before the exam.

◈ Bring snacks to the center to keep in your locker in case you choose to take a break during the exam.

◈ Arrive early to the testing center, prepared with necessary documents for testing.

◈ Put gas in your car the night before.

◈ Set a reliable alarm.

◈ Bring clothes you can layer in case you tend to get cold. If you try to control your environment as much as possible, it will help you to feel comfortable and prepared for the exam itself.

◈ Schedule your exam time with your usual preference for testing. If you are a morning person, schedule a morning test. If you enjoy slow mornings and sleeping in, then schedule an afternoon exam.

10. BELIEVE IN YOURSELF

Most importantly, believe in yourself. You deserve to pass and you have already proven your potential as a nurse by graduating nursing school. This is only the final step on your exciting and new journey to being a Registered Nurse – so congratulations!

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Question Of The Day: Neurosensory Disorders

Q. Which of the following is an early symptom of glaucoma?

A. Hazy vision.
B. Loss of central vision.
C. Blurred or "sooty" vision.
D. Impaired peripheral vision.




Correct Answer: D

Explanation: In glaucoma, peripheral vision is impaired long before central vision is impaired. Hazy, blurred, or distorted vision is consistent with a diagnosis of cataracts. Loss of central vision is consistent with senile macular degeneration but it occurs late in glaucoma. Blurred or "sooty" vision is consistent with a diagnosis of detached retina.

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Question Of The Day: Mood, Adjustment, and Dementia Disorders

Q. A nurse is monitoring a client receiving tranylcypromine sulfate (Parnate). Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor?

A. Hypotensive episodes
B. Hypertensive crisis
C. Muscle flaccidity
D. Hypoglycemia


Correct Answer: B

Explanation: The most serious adverse reaction associated with high doses of MAO inhibitors is hypertensive crisis, which can lead to death. Although not a crisis, orthostatic hypotension is also common and may lead to syncope with high doses. Muscle spasticity (not flaccidity) is associated with MAO inhibitor therapy. Hypoglycemia isn't an adverse reaction of MAO inhibitors.

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